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Written by Andrea Grimes for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Texas women struggle to see doctors they trust after changes to health care programs.

Without Planned Parenthood, the new Texas Women’s Health Program (TWHP) has seen a 23 percent reduction in medical claims and thousands fewer Texans enrolled in the program in the first half of 2013 as compared to the same period last year, when the program was still the Medicaid Women’s Health Program. The state’s explanation? Women just don’t want to change doctors.

“We expected to see a drop off in the number of claims when we moved to the state program because we knew some women wouldn’t want to change doctors,” said Texas Health and Human Services Commission (HHSC) spokesperson Stephanie Goodman in a statement this week.

Goodman’s statement is at best glib and at worst a kind of victim-blaming that puts the responsibility for the state’s failure to provide low-cost reproductive health care squarely on the shoulders of the very people it is supposed to be serving.

The TWHP provides contraceptives and well-woman exams to low-income Texans. From 2007 to 2012, it operated as part of Medicaid, receiving a 90 percent federal match in funds and, at peak enrollment, saw almost 130,000 clients. But in 2012, the state kicked Planned Parenthood out of participating in the program because it considers the organization to be an abortion “affiliate” and thereby ineligible to provide health care using public funds in Texas. At that time, the federal government dropped its support of the program because the arbitrary exclusion of any qualified health provider from a Medicaid program is a violation of the Social Security Act, which dictates that Medicaid enrollees have a right to receive care from the physician of their choosing. To fund a program that denies Texans the ability to see the qualified doctor of their choice would, according to the Center for Medicaid Services, be a violation of its own law.

Undeterred, Texas launched a new, entirely state-funded Women’s Health Program in January of this year, and so far it has seen its service numbers plummet without the involvement of Planned Parenthood, which historically saw about half of all Women’s Health Program patients.

According to preliminary data provided by the Texas HHSC, current enrollment in TWHP is estimated to be about 97,000 clients, the lowest number of enrollees since September 2009, when the program was just two-and-a-half years old. This July, the TWHP counted over 10,000 fewer enrollees than it did in the same month last year. Add this to the fact that, according to the University of Texas’ Texas Policy Evaluation Project (TPEP), more than 60 family planning clinics in Texas—most of which were not Planned Parenthood facilities—have closed since 2011 due to family planning funding cuts, and it’s clear that there’s a serious, and growing, hole in Texas’ reproductive health safety net.

And yet the state says that if fewer and fewer low-income Texans are receiving publicly funded reproductive health care, it must be because women don’t want to change doctors. Considering the very real logistical, physical, and emotional challenges women face now that they have been forced by the state government to find new reproductive health providers, the HHSC’s statement seems an egregious simplification of a deeply complex and personal issue.

Amanda Stevenson, a TPEP researcher who studies the impact of family planning budget cuts on low-income Texans, told RH Reality Check that research shows changing doctors is not simply about personal preferences, but rather about the complex ways Texans choose their providers and the many factors that influence their decisions.

“There’s lots of other complexities that are hidden by [Goodman's] statement,” Stevenson said, citing spatial distribution and capacity of providers as just two factors that affect whether someone is able to switch to a new doctor. “Maybe you don’t want to go to a doctor who is 50 miles from you, but you also sort of can’t,” she said. “Preference is not the right framework for this.”

Written by Andrea Grimes for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Photo: Bad Lyric Police / Flickr

A new university study has found Texas wanting when it comes to reproductive health care in the state. Researchers at George Washington University have found that if Texas manages to exclude Planned Parenthood from participating in the Texas Women’s Health Program (WHP), “tens of thousands of low-income Texas women could lose access to affordable family planning services and to other women’s health services.”

GWU has had its eye on the state since May, when it released a report questioning claims by Texas’s Department of Health And Human Services that non-Planned Parenthood providers could easily see the 50,000 or so Texans who currently rely on Planned Parenthood for breast and cervical cancer screenings, contraceptive supplies, and other basic preventive care. Lawmakers in Texas want to exclude Planned Parenthood from the program because they consider it an abortion “affiliate,” even though no Planned Parenthood clinic enrolled in the WHP provides abortions and the WHP itself cannot ever be used to serve a pregnant person — it’s intended solely for the use of Texans who do not want to be, and who are not, pregnant.

The study released this week casts even more doubt on the state’s ability to find new providers to pick up the slack, focusing especially on poorer rural areas where alternatives to Planned Parenthood are few.

Where alternatives do exist, researchers concluded, “they are generally at, or close to, the limits of their capacity and will not be able to expand much, if at all, due to other resource or staffing constraints. There is no evidence that they are prepared to sustain the very large caseload increases that would be required to fill the gaps left after Planned Parenthood affiliates are excluded.”

In a statement released today by HHSC Executive Commissioner Kyle Janek in response to the study, the department says it intends to add new providers to the program on top of the 500 added since the spring. “We’re confident that we’ll be able to provide women with access to family planning services and fully comply with state law that bans abortion providers and affiliates from the program.”

In his statement, Janek said that HHSC has “five family planning clinics and more than 70 individual physicians waiting to take the place of every clinic that won’t qualify under the new rule.”

Indeed, if the WHP provider base is not increased in Texas, existing providers will be asked to take on huge numbers of former Planned Parenthood clients. From the GWU study, which looked at five Texas markets, including rural Lubbock, Hidalgo and Midland counties as well as urban Bexar County, which contains San Antonio, and Dallas County:

Written by Andrea Grimes for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

A new report published in the New England Journal Of Medicine, part of a three-year study intended as a direct response to Texas’ drastic family planning cuts in 2011,finds that 53 clinics in the state have closed as a result of a 66 percent reduction in funds championed by conservative lawmakers. But will legislators listen to this new, Texas-focused research that bodes ill for the health and well being of Texans trying to plan their families? Or will they continue to wage a culture war that invigorates a conservative base and decimates programs that do demonstrable good — and that also save money?

Researchers, who interviewed 56 leaders at reproductive health providers and organizations in Texas, characterized the state’s health care network as an “unfortunate situation.” They found that the new policies “are limiting women’s access to a range of preventive reproductive health services and screenings,” creating “circumstances that force clinics and women in Texas to make sacrifices that jeopardize reproductive health and well-being.”

It’s the hope of Dr. Joseph Potter of the Population Research Center at the University of Texas at Austin, who is leading the project, that his Texas-focused research will give legislators the information they need to see just how these policies affect “their most vulnerable constituents.”

“It seems to me that the decisions made in the last session were made without much local information about their likely consequences,” Dr. Potter told RH Reality Check in an e-mail interview. “My hope is that when legislators have more information about what the cuts have meant for their most vulnerable constituents, they might decide to restore lost funding.”

Indeed, discussions around the 2011 cuts centered almost exclusively around Planned Parenthood, and Republican legislators’ professed intent to de-fund the reproductive health care provider at all costs. Never mind the fact that absolutely no public money can be used to fund safe abortion care, according to both federal law and state law.

Legislators claimed that there would be no reduction in access to care as a result of the slashed budget, but an RH Reality Check investigation that I conducted last year in Dallas found those claims to be completely without merit. Not only does Planned Parenthood provide low-cost reproductive health care to many thousands of Texans who would be forced to go elsewhere without Planned Parenthood, but the cuts ensure that the non-Planned Parenthood options, like federally-qualified health centers and other low-cost clinics, would have even fewer resources available to pick up the slack.

My investigation was a precursor to the early results of the University of Texas study, which found: closed clinics, a reduction in services at clinics that have stayed open, and increased costs to low-income patients who already are forced to make hard choices between getting the health care they need and paying rent or feeding their families. From the report:

“Moreover, the impact of these policies is not limited to Planned Parenthood; other organizations have had to close clinics, reduce hours, and lay off dedicated, experienced staff members. We are witnessing the dismantling of a safety net that took decades to build and could not easily be recreated even if funding were restored soon.”

Already, the UT study has found “restricted access to the most effective contraceptive methods” as organizations cope with “higher up-front costs,” opting to provide a $5 pack of pills over, say, a $250 intra-uterine device. According to the report, less effective contraceptive methods that require women to make multiple visits to the doctor or pharmacy have “been shown to result in lower rates of continuation with the method and that may increase the likelihood of unintended pregnancy — and therefore that of abortion.” This, combined with a reduction in overall access and increased prices for patients, does not bode well for Texans. Because the study is ongoing, it remains to be seen what the actual, quantifiable impact of Texas’ budget cuts will be, but according to Dr. Potter, ”it seems clear that these changes can only lead to higher rates of unintended pregnancy, and less use of preventive services.”

So many of these findings just make good common sense, and there’s already a bevy of existing research that shows that a reduction in unintended pregnancies results in a lower abortion rate, and that access to contraception results in a lower rate of unintended pregnancies — all of which saves taxpayers money. It bears repeating: for every $1 investment in family planning, taxpayers save $3.74 in Medicaid expenditures.

Preventive care and screenings — such as pap smears — mean healthier people, and the earlier an illness is caught, the less likely a patient is to need invasive or expensive treatment. Reducing access to and funding for these things seems clearly ill-conceived if the point is to save money, promote public health and ensure healthy, wanted pregnancies for women who rely on the ability to plan their families so they can achieve their goals in life.

But, if the point is to pander to a conservative base that continues to spread the lie, for example, that contraception is abortion, all the statistics and studies in the world won’t make a difference. Legislators have to be willing to listen to reason rather than be motivated by the prospect of scoring political points.

Written by Andrea Grimes for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Read the rest of Andrea’s coverage of women’s health issues in Texas here and the rest of our coverage on the Texas Women’s Health Program here.

Yesterday, in a packed auditorium at the Texas Department of State Health Services, legislators and supporters of Planned Parenthood in Texas gathered to speak out against proposed rules that would bar Planned Parenthood from participating in the state’s Women’s Health Program, through which PP-Texas has provided the lion’s share of family planning services to low-income women. The new rules are fueled by right-wing lawmakers who want to forgo the available 90 percent of federal funding for the program in order to keep Planned Parenthood–and any other so-called “abortion affiliate”–from providing care via the WHP.

“This is not the better course for a program that is this important,” Texas Sen. Kirk Watson told a panel of DSHS officials. Watson and a group of 24 other Democratic lawmakers requested the public hearing, with Watson calling out DSHS for a “lack of transparency” at yesterday’s meeting. DSHS told RH Reality Check that they called the hearing at the request of lawmakers and also as the result of an online petition from Planned Parenthood supporters.

While a law banning abortion affiliates has been on the books in Texas since 2005, DSHS began enforcing the law this year, excluding the largest provider of WHP services in the state: Planned Parenthood.

“Preventing Planned Parenthood from participating in the Women’s Health Program forces thousands of women to seek alternative providers at the very time we significantly cut the family planning budget in the state,” argued Texas Rep. Donna Howard, referring to the separate but significant cuts in family planning made in 2011.

At the nearly four-hour meeting, forty speakers, including University of Texas reproductive health researchers and community clinic doctors not affiliated with Planned Parenthood, argued in favor of the group’s continued participation in the WHP. Many women spoke through tears about the exams and screenings at Planned Parenthood that had saved them from cervical cancer or allowed them to hold down jobs and school responsibilities when they were struggling to make ends meet.

“It’s really degrading, sitting in a doctor’s office trying to make a decision on whether to pay your utility bill or get medical treatment,” testified one Planned Parenthood supporter. Another spoke up for the accessibility of Planned Parenthood, which could see her more quickly than her regular doctor, at whose office she couldn’t afford to get the treatment she needed.

“Even a week can feel like a really long time when you’re wondering if you have cancer,” said the woman.

Others took more logistical approaches, citing the obvious financial benefits of maintaining a funding structure that tremendously benefits money-strapped Texas. If it excludes Planned Parenthood from the program, Texas is responsible for funding 100 percent of a program it had previously only funded at 10 percent–and officials have said they believe they can provide the same quality of care, despite the state’s budget woes. That didn’t jibe with speaker Sheila Sorvari.

“For all of us who are paying attention and can basically do the math, it’s clear the money doesn’t add up,” she said in an impassioned and occasionally sarcastic speech that drew wild applause from the audience. “I don’t know what’s wrong with our legislators that they’ve decided that facts and data and logic no longer have a place in Texas.”

Sorvari also didn’t buy the line that excluding Planned Parenthood from the WHP wouldn’t affect access to providers

“Offer everyone a door-to-door car service,” she suggested to DSHS, if women were now going to be asked to avoid the Planned Parenthood clinics closest to their homes.

A handful of anti-Planned Parenthood speakers attended the meeting, including notorious Planned Parenthood defector Abby Johnson, who has made a career out of her role as a former clinic director.

“There are no doctors at Planned Parenthood health centers,” she said, claiming that Planned Parenthood provides Medicaid-funded abortions on demand at every clinic. She gave her speech over murmers of a crowd quietly grumbling and contradicting her at every opportunity.

The final minutes of the meeting were dominated by anti-Planned Parenthood speakers who took the opportunity to rail not only against abortion but against the evils of birth control.

“It’s synthetic,” said one woman, who said she didn’t understand why women would poison their bodies with contraception. Another woman said she knew abortion was wrong because, as a sidewalk protestor outside abortion clinics, she’d seen women who’d just gotten abortions and “they don’t look very good at all.”

Most everyone who spoke thanked DSHS for hearing their concerns, especially Scott Braddock, a Texas broadcast journalist who spoke out in favor of Planned Parenthood, which he said had saved his friend’s life.

“Can you hear me?” Braddock said into the auditorium’s microphone. “Because there are too many women not being heard here.”

Written by Rene Resendez forRH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post. For all our coverage of the cuts to the Texas Women’s Health Program, click here.

In Texas, a state where more than one-quarter of women are uninsured, the Women’s Health Program provides preventive health care, including birth control and lifesaving cancer screenings, to more than 130,000 low-income women each year. The federal government, which covers 90 percent of the cost of this program, has made clear to Texas — and to all 50 states — that a rule excluding a comprehensive women’s health care provider like Planned Parenthood restricts the rights of patients and will not be allowed in the Medicaid program. However, Governor Rick Perry and Texas lawmakers are moving forward to disallow Planned Parenthood from participating in the WHP, today.

On March 8, in the midst of a budget deficit, Gov. Perry said the state would reject the nine- to-one federal matching dollars and instead find money in the state budget to pay for the WHP, although it is not clear where the money will be found. Already in the past few months, budget cuts passed by the state legislature and signed by Gov. Perry cut the state’s family planning program by more than two-thirds, taking away health care from another 160,000 women a year.

Planned Parenthood is the single largest provider of care within the Texas Medicaid Women’s Health Program. More than 40 percent of the women who received vital health care through the Texas Women’s Health Program rely on a Planned Parenthood health center for their preventive health care.

My name is Rene, and I am graduate student. I am also on the WHP. I’ve been a WHP patient for five years. My mom was diagnosed with cervical cancer when she was my age, while pregnant with my sister — this means I am at a 2-3 times increased risk for cervical cancer than other women. Because of my family history, I need to get a check-up every year.

My sister is a college student and also on the WHP. She needs contraception to keep her ovarian cysts under control. Because of the WHP and Planned Parenthood, we can focus on our studies instead of worrying about paying for contraception and cancer screenings. Read the rest of this entry →

Written by Andrea Grimes forRH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post. For all our coverage of the cuts to the Texas Women’s Health Program, click here.

On March 14th, 2012, at least 300,000 low-income and uninsured Texas women will have no or greatly-reduced access to basic preventive and reproductive health care due to the loss of federal funding for the Medicaid Women’s Health Program in the state. The program has been under threat for months as lawmakers fight over whether it’s legal to exclude Planned Parenthood from the program.

On Friday, U.S. Health and Human Services Secretary Kathleen Sebelius told reporters in Houston that the federal government would not extend its waiver, which provided about 90 percent of the cost of the program. It is against federal law to exclude “qualified providers” from providing Medicaid care, and while the federal government considers Planned Parenthood “qualified,” the state of Texas does not. Since 2005, legislators in Texas have sought specifically to block Planned Parenthood from participating in the Women’s Health Program in Texas, when they voted into place a state law, only just now enforced, that bars “affiliates” of abortion providers from receiving funds. Planned Parenthood uses no taxpayer dollars to provide abortions and keeps its abortion services wholly financially separate from its non-abortion services.

“We’re questioning the governor saying he’s going to continue the funding with state money,” Planned Parenthood of North Texas representative Kelly Hart told RH Reality Check, “and why the state would want to go forward to spend more money to provide care to fewer women.” Hart says Planned Parenthood expects to be able to provide WHP care until they’re phased out in late April so that “more women can have that last chance to get their annual exam.” Read the rest of this entry →

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